Extended Work Hours and Patient, Nurse, and Organizational Outcome

Purpose: The purpose of this study is to examine for the first time in Thailand nurses’ extended work hours and its relationship to patient, nurse, and organizational outcomes.

Methods: The mothod of this study used a multistage sampling 1,524 registered nurses working in 90 hospitals in all levels of hospital. They are from district hospitals, provincial hospitls, regional hospitals and university hospitals  across  Thailand. Sample completed a demographic form, the Nurses’ Extended Work Hours Form; the Patient, Nurse, Organizational Outcomes Form; the Organizational Productivity Questionnaire; and the Maslach Burnout Inventory. Data were analyzed using descriptive statistics, Spearman's Rank Correlation, and logistics regression. Approval was obtained from the Institutional review board (IRB) committee of the Faculty iof Nursing Chiang Mai University as well as all hospitals involved.

Results: Results showed that the average extended work hours of respondents was18.82 hrs/wk. About 80% had worked two consecutive shifts. Extended work hours had a positive correlation with patient outcomes such as identification errors, pressure ulcers, communication errors and patient complaints, and with nurse outcomes of emotional exhaustion, and depersonalization. Further, we found a negative correlation between extended work hours and job satisfaction as a whole, intent to stay, and organizational productivity. Findings demonstrate that working two shifts (16 hours) more than regular work hours lead to negative outcomes for patients, nurses and the organization.   

Conclusion: In conclusion long extended work hours (18.82 hrs/wk) were rated by respondents. Associations between extended work hours and outcomes for patients, nurses, and the organization were found.  Our findings add to increasing international evidence that nurse’ poor working conditions results in negative outcomes for the profession, patients and health systems. Policymakers need to be aware of the issues regarding nurses’ extended work hours which has been found to contribute to burnout. Urgently, nurse and health administrators need to develop and implement appropriate nursing overtime policies and strategies to help reduce this phenomenon, including measures to overcome the nursing shortage.